et eg Fi x ao 9 JUL 25 2008 . DEPARTMENT OF rong Cs /s s Rooxctoa by: Sk, Tom GALLAGHER CHIEF FINANCIAL OFFICER IN THE MATTER OF: CASE NO. 63149-03-AG CAROLE SUZANNE MAYNER : / ADMINISTRATIVE COMPLAINT TO: CAROLE SUZANNE MAYNER 2818 John Moore Road Brandon, Florida 33511-7125 You, CAROLE SUZANNE MAYNER, are hereby notified that pursuant to Chapter 626, Florida Statutes, the Chief Financial Officer for the State of Florida, has caused to be made an investigation of your activities while licensed as an insurance agent in this state, as a result of which it is alleged: GENERAL ALLEGATIONS 1. You, CAROLE SUZANNE MAYNER, are currently licensed in the state as a health agent (2-40), legal expense agent (2-56), and life and health insurance agent (2-18). 2. At all time pertinent to the dates and occurrences referred to in this Administrative Complaint you, CAROLE SUZANNE MAYNER, were licensed as an insurance agent in this state. CQUNTI 3. Paragraphs one through two are realleged and incorporated herein by reference. 4, On or about January 18, 2002, you, CAROLE SUZANNE MAYNER, submitted to American Family Life Assurance Company (hereinafter “AFLAC”) a fraudulent application for a short-term disability insurance policy with Patricia S. Shepherd of Seminole, Florida as the purported applicant. 5. You, CAROLE SUZANNE MAYNER, on or about January 18, 2002, without Patricia S. Shepherd’s knowledge or informed consent, submitted a false and fraudulent insurance application, to the insurer with the false signatures of Patricia S. Shepherd fraudulently affixed thereto. 6. You, CAROLE SUZANNE MAYNER, on or about January 18, 2002, represented to Patricia S. Shepherd that the disability insurance policy that you were preparing for her would become effective immediately. You, CAROLE SUZANNE MAYNER, a week later represented to Patricia S. Shepherd in her office that the policy did not go into effect on January 18, 2002, as previously stated, but on the following day, January 19, 2002, and that AF LAC was willing to pay half of the claim for Mrs. Shepherd’s husband's automobile accident. 7. As of February 5, 2003, no claims have been paid to Mrs. Shepherd. 8. You, CAROLE SUZANNE MAYNER, by falsely preparing the application for insurance, failed to allow Patricia S. Shepherd an opportunity to provide her correct medical conditions. You, CAROLE SUZANNE MAYNER, without Patricia S. Shepherd’s knowledge or informed consent, submitted application to the insurance company with the signature of Patricia S. Shepherd fraudulently affixed thereto. You, CAROL SUZANNE MAYNER provided false information to Mrs. Shepherd regarding her coverage of her policy, which you falsely 2 submitted to AFLAC. These representations made by you, CAROLE SUZANNE MAYNER, to aclient and an insurance company were false material misstatements of fact. IT IS THEREFORE CHARGED that you, CAROLE SUZANNE MAYNER, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Financial Services which constitute grounds for the suspension or revocation of your insurance licenses and eligibility for licensure: (a) Willful misrepresentation of any insurance policy or annuity contract or willful deception with regard to any such policy or contract, done either in person or by any form of dissemination of information or advertising. [Section 626.611(5), Florida Statutes]; (b) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.611(7), Florida Statutes]; (c) Fraudulent or dishonest practices in the conduct of business under the license or permit. [Section 626.611(9), Florida Statutes]; (d) Unlawfully rebating, attempting to unlawfully rebate, or unlawfully dividing or offering to divide his or her commission with another. [Section 626.611(11), Florida Statutes]; (e) Misrepresentations and false advertising of insurance policies.--Knowingly making, issuing, circulating, or causing to be made, issued, or circulated, any estimate, illustration, circular, statement, sales presentation, omission, or comparison which: Misrepresents the benefits, advantages, conditions, or terms of any insurance policy. [Section 626.9541(a)(1), Florida Statutes]; (Ga) False information and advertising generally.--Knowingly making, publishing, disseminating, circulating, or placing before the public, or causing, directly or indirectly, to be made, published, disseminated, circulated, or placed before the public: a statement containing 3 any assertion, representation, or statement with respect to the business of insurance, which is untrue, deceptive, or misleading. [Section 626.9541(b) Florida Statutes] (g) False statements and entries. — 1, Knowingly: a. Filing with any supervisory or other public official, b. Making, publishing, disseminating, circulating, c. Delivering to any person, d. Placing before the public, e. Causing, directly or indirectly, to be made, published, disseminated, circulated, delivered to any person, or placed before the public, any false material statement. [Section 626.9541(1)(e)(1), Florida Statutes}. COUNT II 9. Paragraphs one through two are realleged and incorporated herein by reference. 10. On or about January 18, 2002, you, CAROLE SUZANNE MAYNER, submitted to AFLAC a fraudulent application for a short term disability insurance policy with Corina S. Rust of Clearwater, Florida as the purported applicant. 11. You, CAROLE SUZANNE MAYNER, on or about January 18, 2002, without Corina S. Rust’s knowledge or informed consent, submitted a false and fraudulent insurance application, to the insurer with the false signatures of Corina S. Rust fraudulently affixed thereto. 12. You, CAROLE SUZANNE MAYNER, on or about January 18, 2002, represented to Corina S. Rust that the disability insurance policy that you were preparing for her would have a 7-day waiting period when the actual policy provides a 14-day waiting period. You, CAROLE SUZANNE MAYNER, represented to Corina S. Rust that the hospital indemnity 4 policy would cover $100 a day after the first day of hospital stay/admission, when the actual policy provides for $50 a day after the first day. 13. You, CAROLE SUZANNE MAYNER, by falsely preparing the application for insurance, failed to allow Corina S. Rust an opportunity to provide her correct medical conditions. You, CAROLE SUZANNE MAYNER, without Corina S. Rust’s knowledge or informed consent, submitted application to the insurance company with the signature of Corina S. Rust fraudulently affixed thereto. You, CAROL SUZANNE MAYNER provided false information to Ms: Rust regarding her coverage of her policies, which you falsely submitted to AFLAC. These representations made by you, CAROLE SUZANNE MAYNER, to a client and an insurance company were false and material misstatements of fact. IT IS THEREFORE CHARGED that you, CAROLE SUZANNE MAYNER, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Financial Services which constitute grounds for the suspension or revocation of your insurance licenses and eligibility for licensure: Sections 626.611(5); 626.611(7), 626.611(9), 626.61 1(11), 626.9541(a)(1), 626.9541(b), 626.9541(1)(e)(1), Florida Statutes which are set forth specifically in Count I above and are hereby realleged and fully incorporated herein by reference. COUNT III 14. Paragraphs one through two are realleged and incorporated herein by reference. 15. On or about January 18, 2002, you, CAROLE SUZANNE MAYNER, submitted to AFLAC a fraudulent application for a short term disability insurance policy with Theresa Marie Inrgam-Heller of St. Petersburg, Florida as the purported applicant. 16. You, CAROLE SUZANNE MAYNER, on or about January 18, 2002, without Theresa Marie Ingram-Heller’s knowledge or informed consent, submitted a false and fraudulent insurance application, to the insurer with the false signatures of Theresa Marie Ingram-Heller fraudulently affixed thereto. 17. You, CAROLE SUZANNE MAYNER, by falsely preparing the application for insurance, failed to allow Theresa Marie Ingram-Heller an opportunity to provide her correct medical conditions. You, CAROLE SUZANNE MAYNER, without Theresa Marie Heller’s- Heller’s knowledge or informed consent, submitted application to the insurance company with the signature of Theresa Marie Heller-Heller fraudulently affixed thereto. These representations made by you, CAROLE SUZANNE MAYNER, to an insurance company was a false and material misstatement of fact. IT IS THEREFORE CHARGED that you, CAROLE SUZANNE MAYNER, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Financial Services which constitute grounds for the suspension or revocation of your insurance licenses and eligibility for licensure: Sections 626.611(5); 626.611(7), 626.611(9), 626.611(11), 626.9541(a)(L), 626.9541 (b), 626.9541(1)(e)(1), Florida Statutes which are set forth specifically in Count I above and are hereby realleged and fully incorporated herein by reference. COUNT IV 18. Paragraphs one through two are realleged and incorporated herein by reference. 19. On or about January 18, 2002, you, CAROLE SUZANNE MAYNER, submitted to AFLAC a fraudulent application for a short term disability insurance policy with Tanya Lea Wollner of St. Petersburg, Florida as the purported applicant. 6 20. You, CAROLE SUZANNE MAYNER, on or about January 18, 2002, without Tanya Lea Wollner’s knowledge or informed consent, submitted a false and fraudulent insurance application, to the insurer with the false signatures of Tanya Lea Wollner fraudulently affixed thereto. 21. You, CAROLE SUZANNE MAYNER, by falsely preparing the application for insurance, failed to allow Tanya Lea Wollner an opportunity to provide her correct medical conditions. You, CAROLE SUZANNE MAYNER, without Tanya Lea Wollner’s knowledge or informed consent, submitted application to the insurance company with the signature of Tanya Lea Wollner fraudulently affixed thereto. These representations made by you, CAROLE SUZANNE MAYNER, to an insurance company was a false and material misstatement of fact. IT IS THEREFORE CHARGED that you, CAROLE SUZANNE MAYNER, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Financial Services which constitute grounds for the suspension or revocation of your insurance licenses and eligibility for licensure: Sections 626.611(5); 626.611(7), 626.611(9), 626.611(11), 626.9541 (a)(1), 626.9541(b), 626.9541(1)(e)(1), Florida Statutes which are set forth specifically in Count I above and are hereby realleged and fully incorporated herein by reference. COUNT V 22. Paragraphs one through two are realleged and incorporated herein by reference. 23. On or about January 18, 2002, you, CAROLE SUZANNE MAYNER, submitted to AFLAC a fraudulent application for a short term disability insurance policy with Brigitte Schwarz Cziesla of St. Petersburg, Florida as the purported applicant. 24. You, CAROLE SUZANNE MAYNER, on or about January 18, 2002, without Brigitte Schwarz Cziesla s knowledge or informed consent, submitted a false and fraudulent insurance application, to the insurer with the false signatures of Brigitte Schwarz Cziesla fraudulently affixed thereto. 25. You, CAROLE SUZANNE MAYNER, by falsely preparing the application for insurance, failed to allow Brigitte Schwarz Cziesla an opportunity to provide her correct medical conditions. You, CAROLE SUZANNE MAYNER, without Brigitte Schwarz Cziesla’s knowledge or informed consent, submitted application to the insurance company with the signature of Brigitte Schwarz Cziesla fraudulently affixed thereto. These representations made by you, CAROLE SUZANNE MAYNER, to an insurance company was a false and material misstatement of fact. IT IS THEREFORE CHARGED that you, CAROLE SUZANNE MAYNER, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Financial Services which constitute grounds for the suspension or revocation of your insurance licenses and eligibility for licensure: Sections 626.611(5); 626.611(7), 626.611(9), 626.611(11), 626.9541 (a)(1}, 626.9541(b), 626.9541(1)(e)(1), Florida Statutes which are set forth specifically in Count I above and are hereby realleged and fully incorporated herein by reference. COUNT VI 26, Paragraphs one through two are realleged and incorporated herein by reference. 27. On or about January 18, 2002, you, CAROLE SUZANNE MAYNER, submitted to AFLAC a fraudulent application for a short term disability insurance policy with Dianne D, Crayne of St. Petersburg, Florida as the purported applicant. 8 28. You, CAROLE SUZANNE MAYNER, on or about January 18, 2002, without Dianne D. Crayne’s knowledge or informed consent, submitted a false and fraudulent insurance application, to the insurer with the false signatures of Dianne D. Crayne fraudulently affixed thereto. 29, You, CAROLE SUZANNE MAYNER, by falsely preparing the application for insurance, failed to allow Dianne D. Crayne an opportunity to provide her correct medical conditions. You, CAROLE SUZANNE MAYNER, without Dianne D. Crayne’s knowledge or informed consent, submitted application to the insurance company with the signature of Dianne D. Crayne fraudulently affixed thereto. These representations made by you, CAROLE SUZANNE MAYNER, to an insurance company was a false and material misstatement of fact. IT IS THEREFORE CHARGED that you, CAROLE SUZANNE MAYNER, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Financial Services which constitute grounds for the suspension or revocation of your insurance licenses and eligibility for licensure: Sections 626.611(5); 626.611(7), 626.611(9), 626.611(11), 626.9541 (a)(1), 626.9541(b), 626.9541(1)(e)(1), Florida Statutes which are set forth specifically in Count I above and are hereby realleged and fully incorporated herein by reference. | COUNT VII 30. Paragraphs one through two are realleged and incorporated herein by reference. 31. On or about January 18, 2002, you, CAROLE SUZANNE MAYNER, submitted to AFLAC a fraudulent application for a short term disability insurance policy with Alma L. Cunningham of St. Petersburg, Florida as the purported applicant. 32. You, CAROLE SUZANNE MAYNER, on or about January 18, 2002, without Alma L. Cunningham’s knowledge or informed consent, submitted a false and fraudulent insurance application, to the insurer with the false signatures of Alma L. Cunningham fraudulently affixed thereto. 33. On or about June 10, 2002, you, CAROLE SUZANNE MAYNER, sent to Alma L. Cunningham a check # 407 from Mayner Inc., signed by you, CAROLE SUZANNE MAYNER, in the amount of $1,500.00 representing a claim payment from AFLAC for her knee surgery. oa 34. On or about June 17, 2002, Alma L. Cunningham received notification from AFLAC that they could not process the above mentioned claim due to missing documentation. 35. Alma L. Cunningham later received notification from AFLAC informing her that her policy would be rescinded due to the answers provided on the application. 36. At that point, Alma L. Cunningham contacted you, CAROLE SUZANNE MAYNER, regarding the aforementioned notification from AFLAC, and you responded that you would look into it. 37. On or about August 19, 2002, you, CAROLE SUZANNE MAYNER, came to the home of Alma L. Cunningham with a check #429 from Mayner Inc., signed by you, CAROLE SUZANNE MAYNER, in the amount of $7,500.00. You, CAROLE SUZANNE MAYNER, wrote a handwritten note that states that this check would resolve all issues with AFLAC from this date forward. 38. You, CAROLE SUZANNE MAYNER, by falsely preparing the application for insurance, failed to allow Alma L. Cunningham an opportunity to provide her correct medical conditions. You, CAROLE SUZANNE MAYNER, without Alma L. Cunningharn’s knowledge 10 or informed consent, submitted application to the insurance company with the signature of Alma L. Cunningham fraudulently affixed thereto. These representations made by you, CAROLE SUZANNE MAYNER, to an insurance company was a false and material misstatement of fact. IT IS THEREFORE CHARGED that you, CAROLE SUZANNE MAYNER, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Financial Services which constitute grounds for the suspension or revocation of your insurance licenses and eligibility for licensure: Sections 626.61 1(5); 626.611(7), 626.611(9), 626.611(11), 626.9541 (a)(1), 626.9541(b), 626.9541(1)(e)(1), Florida Statutes which are set forth specifically in Count I above and are hereby realleged and fully incorporated herein by reference. WHEREFORE, you, CAROL SUZANNE MAYNER, are hereby notified that the Chief Financial Officer intends to enter an Order suspending or revoking your licenses and appointments ands an insurance agent or to impose such penalties as may be provided under the provisions of Sections 626.611, 626.621, 626.681, 626.691, and 626.9521, Floride Statutes, and under the other referenced sections of the Florida Statutes as set out in this Administrative Complaint. You are further notified that any order entered in this case revoking or suspending any license or eligibility for licensure held by you shall also apply to all other licenses and eligibility held by you under the Florida Insurance Code. NOTICE OF RIGHTS You have the right to request a proceeding to contest this action by the Department pursuant to sections 120.569 and 120.57, Florida Statutes, and Rule 28-107, Florida Administrative Code. The proceeding request must be in writing, signed by you, and must be filed with the Department within twenty-one (21) days of your receipt of this notice. Completion 1] of the attached Election of Proceeding form and/or a petition for administrative hearing will suffice as a written request. The request must be filed with the General Counsel as acting Agency Clerk, at the Florida Department of Financial Services, 612 Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0333. Your written response must be received by the Department no later than 5:00 p.m. on the twenty-first day after your receipt of this notice. Mailing the response on the twenty-first day will not preserve your right to a hear.ng, YOUR FAILURE TO RESPOND IN WRITING WITHIN TWENTY-ONE (21) DAYS OF YOUR RECEIPT OF THIS NOTICE WILL CONSTITUTE A WAIVER OF YOUR RIGHT TO REQUEST A PROCEEDING ON THE MATTERS ALLEGED HEREIN AND AN ORDER OF REVOCATION WILL BE ENTERED AGAINST YOU. If you request a proceeding, you must provide information that complies with the requirements of Rule 28-107.004, Florida Administrative Code. As noted above, completion of the attached Election of Proceeding form conforms to these requirements. Specifically, your response must contain: (a) The name and address of the party making the request, for purpose of service; (b) A statement that the party is requesting a hearing involving disputed issues of material fact, or a hearing not involving disputed issues of material fact; and (c) A reference to the notice, order to show cause, administrative complaint, or other communication that the party has received form the agency. If a hearing of any type is requésted, you have the right to be represented by counsel or other qualified representative at your expense, to present evidence and argument, to call and cross-examine witnesses, and to compel the attendance of witnesses and the production of documents by subpoena. 12 If a proceeding is requested and there is no dispute of material fact, the provisions of section 120.57(2), Florida Statutes, apply. In this regard, you may submit oral or written evidence in opposition to the action taken by the Department or a written statement challenging the grounds upon which the Department has relied. While a hearing is normally not required in the absence of a dispute of fact, if you feel that a hearing is necessary, one will be conducted in Tallahassee, Florida, or by telephonic conference call upon your request. However, if you dispute material facts which are the basis for the Departments action, you must request an adversarial proceeding pursuant to sections 120.569 and 120.57(1), Florida Statutes. These proceedings are held before a State administrative law judge of the Division of Administrative Hearings. Unless the majority of witnesses are located elsewhere, the Department will request that the hearing be conducted in Tallahassee, Florida. Failure to follow the procedure outlined with regard to your response to this notice may result in the request being denied. All prior oral communication or correspondence in this matter shall be considered freeform agency action, and no such oral communication or correspondence shall operate as a valid request for an administrative proceeding. Any request for an administrative proceeding received prior to the date of this notice shall be deemed abandoned unless timely renewed in compliance with the guidelines as set out above. Mediation of this matter pursuant to section 120.573, Florida Statutes, is not available. No Department attorney will discuss this matter with you until the Department of Financial Services has received the response. 13 DATED and SIGNED this_25tn day of _guiy , 2003 KAREN CHANDLER Deputy Chief Financial Officer 14 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Administrative Complaint was mailed by certified mail to: CAROLE SUZANNE MAYNER, 2818 John Moore Road, Brandon, Florida 33511-7125, on this 25’ dayof _ ‘Ju ly , 2003. —? aed / CAG ES A. BOSSART, ESQUIRE ivision of Legal Services 612 Larson Building Tallahassee, FL 32399-0333 (850) 413-4124 15

Docket for Case No: 03-003083PL